One of the big changes in Trumpcare versus Obamacare will be the proliferation of underwritten insurance policies. This is because the recent executive order for longer limited duration plans and association plans will create more underwritten policies to be sold. More importantly, the repeal of the individual mandate will take away the incentive for healthy people who don’t qualify for large subsidies to buy community rated policies.
I am fundamentally surprised that the Medicaid expansion and the subsidized market regulations will have survived 2017 and I am slightly optimistic that they will survive 2018 and beyond as well. But that is not what I want to talk about today. Instead, I want to talk about two ends of the underwritten market. It is not all bad, and it is not all good. We need to acknowledge that.
The first end is from my former employer, UPMC Health Plan. UPMC offers the Guaranteed Renewable Individual Product (GRIP). GRIP is a medically underwritten plan that has grandmother (If you like, you can keep it) status. It is a good plan if you qualified for it. The network is the equivilent of the UPMC Premium network with every hospital in the commercial PPO/EPO network and every doctor. This means at least 100 hospitals in Western and Central Pennsylvania as well as 10,000 or more docs. This network is bigger than the two narrow UPMC Exchange networks by a significant margin. Customer service is solid and pricing is good. The 2018 rate filing. The Gold equivalent (EPO $1000) for a perfectly healthy 40 year old male is $120 less per month than the Exchange Gold in zip code 15219. That same plan saves a perfectly healthy woman $25 per month than the lowest cost Exchange Gold. Bronze plan equivalents save men a little bit of money and cost women a bit more. Fundamentally, GRIP, if one could pass the underwriting without any denials or upcharges is good insurance with a broad network and good pricing because the insured cohort is fairly unlikely to actually incur large claims.
That is the best case scenario. Premiums could probably be decreased if UPMC offered narrower networks like their Partner and Select Exchange networks for GRIP.
The other end of the underwritten world is Homeport Health. Charles Gaba collates the audacity of the angle:
So I googled Homeport Healthcare. Check out this page on their website: https://t.co/yoT6PijmCV pic.twitter.com/lujNSnffUR
— Jay Norris (@lukkyjay) December 14, 2017
In other words, if you’re diagnosed with cancer at the same time that you happen to be getting married, divorced, giving birth, adopting a child, moving to a different state, etc. during the 10 month “off season”, they’ll “assist” you in enrolling in an ACA-compliant policy via a Special Enrollment Period.
Basically, this is a savings account and catastrophic reinsurance selling firm that intends to make money by skimming healthy people into cash-pay situations and sending as many sick people to the Exchanges.
UPMC GRIP is decent insurance for the people who qualify. That is not a major worry about the provision of financial protection. Homeport Health is the problem to worry about when we think about minimally regulated firms offer “health insurance like” products that provide as much protection as the Jets have competent quarterbacks.
WereBear
No one has to tell me about the Great American Healthcare Lottery. It’s great… unless you get sick enough to actually need it.
guachi
Wow. That’s more scammy than I would have imagined. Telling people not to pay the no-insurance tax. Faking people being “employees” who have lost insurance.
satby
@WereBear: it’s why I look seriously at becoming an expatriate, so that affordable first world health care will be available to me. It won’t be here, but it will in other countries where I can get a resident visa. I’m not willing to be sacrificed on the alter of greed.
WereBear
Nor should you!
Right now, my tactics are two-fold; researching the cutting edge of science to get myself in the best shape possible (which also helps my own health challenges) and unmooring my source of income to be mobile in case I do need to head somewhere else than here.
Mudbrush
It’s like wells-fargo runs the insurance industry.
WereBear
@Mudbrush: It is. This is the new face of American business; parasitism.
We asked for LL Bean gift cards this Christmas; Mr WereBear has been needing a parka for literally years as his old one falls apart, and other clothing items we still treasure now need replacement. So they did and we did and it all went back except for the gloves.
The pants were almost half the stated dimensions. The parka seemed fine until he zipped it up… and the zipper stuck so badly I had to peel it off him like a banana skin. The hat never ever showed up and we got a mysterious $.02 check which seemed to reference it?
When LL Bean has gone down the drain, is there hope for any?!?!?
So now we have to comb their catalog for other things, we don’t exactly need, because the gift cards mean we only get more gift cards in the return. I hear good things about Duluth Trading company, so we are trying that… and laying out money we don’t have, of course.
It’s all part of their Pirate Business Model of lying in wait and taking the treasure and sailing off. Just like the health care I got; where they urged me to get an official diagnosis, then when I showed them I had the condition, they told me it wasn’t medically necessary and refused to pay for it.
Money goes into their system, the consumer gets no value back.
satby
@WereBear: I’m so sorry you’re going through all that. Pirate Business Model is a perfect description of what we deal with here.
chopper
@WereBear:
don’t know the modern history of l.l. bean but i wouldn’t doubt that some shitbag romney type (but i repeat myself) bought it up and immediately dumped the quality into the basement to squeeze as much profit out as possible until people get sick of it and dump the brand. and then they liquidate the business and walk away with all the pension etc money leaving a smoking crater behind.
blackcatsrule
@WereBear: @chopper: Try to avoid shopping at LL Bean. Their quality has plummeted in recent years and Linda Bean is a BIGLY Trump supporter who also called Obama a fascist for proposing the ACA.
tobie
@blackcatsrule: I’m committed to Costco even if they don’t have much, if anything, in the world of high end fashion. Just got a set of kitchen appliances from them. The sticker price seemed but when I realized it included installation and local permits it was cheaper than Lowes.
MobiusKlein
How is that legal?
Isn’t there some Truth In Advertising law, that calling your product Insurance means it has to insure you?
WereBear
@satby: Thanks, but fortunately what medical science can do is a) not much and b) somewhat affordable.
If my problem was fixable for money and they refused, it would be Guns of Navarone time!